动态心电图在冠心病无症状性心肌缺血中的价值

The value of Holter in silent myocardial ischemia in coronary heart disease

目的 分析动态心电图在冠心病无症状性心肌缺血诊断中的临床应用价值,为该病的诊断提供参考。方法 选取2018年12月—2020年12月茌平区人民医院收治的冠心病患者96例为研究对象,对所有患者进行24 h动态心电图以及冠状动脉造影检查。分析所有患者的检查结果。结果 96例冠心病患者经24 h动态心电图检查后诊断为有症状性心肌缺血患者共9例、占9.38%,24 h内共发作49次,缺血发生时间主要集中在6:00—24:00;无症状性心肌缺血患者共60例、占62.50%,24 h内共发作163次,缺血发生时间主要集中在6:00—24:00。无症状性心肌缺血持续时间>1 min的患者比例高于有症状性心肌缺血,差异有统计学意义(P<0.05);无症状性心肌缺血与有症状性心肌缺血患者的ST段压低幅度比较,差异无统计学意义(P>0.05)。24 h动态心电图诊断冠心病无症状性心肌缺血的漏诊率为13.43%(9/67),误诊率为6.89%(2/29),灵敏度为93.10%(58/67),特异性为86.56%(27/29)。结论 在冠心病无症状性心肌缺血诊断中应用动态心电图,具有较高的灵敏度、特异性,可以有效反映患者心脏供血情况,值得临床推广应用。

Objective To analyze the clinical application value of Holter in the diagnosis of silent myocardial ischemia in coronary heart disease,and provide reference for the diagnosis of this disease.Methods A total of 96 patients with coronary heart disease admitted to Chiping District People's Hospital from December 2018 to December 2020 were selected as the research subjects,and all patients underwent 24 h Holter and coronary angiography examinations.The examination results of all patients were analyzed.Results Among the 96 patients with coronary heart disease,a total of 9 patients were diagnosed with symptomatic myocardial ischemia through 24 h Holter,accounting for 9.38%,experiencing 49 episodes within 24 h,and the onset of ischemia was mainly concentrated from 6:00 to 24:00;there were a total of 60 asymptomatic myocardial ischemia patients,accounting for 62.50%,experiencing 163 episodes within 24 h,and the onset of ischemia was mainly concentrated from 6:00 to 24:00.The proportion of patients with silent myocardial ischemia lasting for more than 1 minute was significantly higher than that with symptomatic myocardial ischemia,and the difference was statistically significant(P<0.05);there was no statistically significant difference in the ST segment pressure depression between silent and symptomatic myocardial ischemia patients(P>0.05).The missed diagnosis rate of silent myocardial ischemia in coronary heart disease diagnosed by 24 h Holter was 13.43%(9/67),the misdiagnosis rate was 6.89%(2/29),the sensitivity was 93.10%(58/67),and the specificity was 86.56%(27/29).Conclusion The application of Holter in the diagnosis of silent myocardial ischemia in coronary heart disease had high sensitivity and specificity,which could effectively reflect the patient's cardiac blood supply situation and was worthy of clinical promotion and application.